Table 1.
Natural history and screening performance characteristics.
| Model characteristics | All patients |
LRA patients * |
HRA patients * |
Ref. † | ||||||
|---|---|---|---|---|---|---|---|---|---|---|
| 50–80 y | 50 y | 60 y | 70 y | 80 y | 50 y | 60 y | 70 y | 80 y | ||
| Adenoma prevalence, % | (29–38) | |||||||||
| Proportion with ≥1 adenoma, % | 100 | 39 | 56 | 66 | 100 | 58 | 73 | 78 | ||
| Proportion with ≥3 adenomas, % ‡ | 0 | 2 | 6 | 10 | 62 | 3 | 10 | 16 | ||
| Proportion with ≥1 large adenoma, % | 0 | 4 | 15 | 29 | 55 | 14 | 36 | 54 | (39) | |
| CRC incidence, 100,000 y−1 | (41) | |||||||||
| Stage I | 0 | 25 | 72 | 124 | 0 | 46 | 129 | 215 | ||
| Stage II | 0 | 38 | 124 | 240 | 0 | 68 | 228 | 441 | ||
| Stage III | 0 | 28 | 90 | 155 | 0 | 53 | 164 | 278 | ||
| Stage IV | 0 | 25 | 84 | 159 | 0 | 50 | 154 | 278 | ||
| Mortality, 100,000 y−1 | ||||||||||
| From CRC | 0 | 29 | 124 | 280 | 0 | 54 | 223 | 508 | (42) | |
| From other causes | 0 | 911 | 2061 | 5700 | 0 | 905 | 2079 | 5727 | (43) | |
| Colonoscopy performance, % | (44) | |||||||||
| Sensitivity for adenoma ≤5 mm | 75 | |||||||||
| Sensitivity for adenoma 6–9 mm | 85 | |||||||||
| Sensitivity for adenoma ≥10 mm | 95 | |||||||||
| Sensitivity for preclinical CRC | 95 | |||||||||
| Completion rate (average reach) | 95 | |||||||||
| Specificity | 85 | (45) | ||||||||
| Perforation rate | 0.5 | 0.9 | 1.7 | 3.1 | 0.5 | 0.9 | 1.7 | 3.1 | (28, 46) | |
| Fatality rate | <0.01 | (47) | ||||||||
| FIT performance, % | (48) | |||||||||
| Sensitivity for adenoma ≤5 mm | 11 | |||||||||
| Sensitivity for adenoma 6–9 mm | 16 | |||||||||
| Sensitivity for adenoma ≥10 mm | 63–89 | |||||||||
| Sensitivity for preclinical CRC | 63–89 | |||||||||
| Specificity | 96 | |||||||||
Abbreviations: CRC = colorectal cancer; FIT = fecal immunochemical test; HRA = high-risk adenoma (≥3 small adenomas or ≥1 large); LRA = low-risk adenoma (1–2 small adenomas); Ref = reference.
The prevalence, incidence, and mortality rates represent model-predicted rates for patients with LRA or HRA removed during screening colonoscopy at age 50 years, followed over time without further intervention. Adenoma prevalence and CRC incidence were calibrated to the data sources in the last column. LRAs were defined as 1–2 tubular adenomas <10 mm in diameter; HRAs were defined as ≥3 or more tubular adenomas <10mm in diameter, and/or ≥1 advanced adenoma (tubular adenoma ≥10 mm in diameter, tubulovillous adenoma, or adenoma with high-grade dysplasia). In the model histology was not described, and an advanced adenoma was considered a large adenoma.
The references informed model-predicted prevalence, incidence, and mortality rates for the U.S. general population. The numbers represent adenoma cohorts from this population.
The number of adenomas per patient is determined by an individual patient risk index, which governs that some patients will develop more adenomas then others.